ABSTRACT: Smoking is the one of the most important modifiable causes of poor pregnancy outcomes in the United States, and is associated with maternal, fetal, and infant morbidity and mortality. The physical and psychologic addiction to cigarettes is powerful; however, the compassionate intervention of the obstetrician–gynecologist can be the critical element in prenatal smoking cessation. An office-based protocol that systematically identifies pregnant women who smoke and offers treatment or referral has been proved to increase quit rates. A short counseling session with pregnancy-specific ed...

ABSTRACT: Given the increasing availability and complexity of genetic testing, it is imperative that the practicing obstetrician–gynecologist or other health care provider has a firm comprehension of the benefits, limitations, and risks of offering a specific genetic test, as well as the importance of appropriate pretest and posttest counseling. The purpose of this Committee Opinion is to provide an outline of how obstetrician–gynecologists and other health care providers can best incorporate these tests into their current practices and provide appropriate pretest and posttest counseling to p...

(Replaces Committee Opinion Number 318, October 2005;Committee Opinion Number 432, May 2009;Committee Opinion Number 442, October 2009;Committee Opinion Number 469, October 2010;Committee Opinion Number 486, April 2011)

ABSTRACT: Carrier screening is a term used to describe genetic testing that is performed on an individual who does not have any overt phenotype for a genetic disorder but may have one variant allele within a gene(s) associated with a diagnosis. Information about carrier screening should be provided to every pregnant woman. Carrier screening and counseling ideally should be performed before pregnancy because this enables couples to learn about their reproductive risk and consider the most complete range of reproductive options. A patient may decline any or all screening. When an individual is ...

ABSTRACT: Carrier screening, whether targeted or expanded, allows individuals to consider their range of reproductive options. Ultimately, the goal of genetic screening is to provide individuals with meaningful information that they can use to guide pregnancy planning based on their personal values. Ethnic-specific, panethnic, and expanded carrier screening are acceptable strategies for prepregnancy and prenatal carrier screening. Because all of these are acceptable strategies, each obstetrician–gynecologist or other health care provider or practice should establish a standard approach that i...

ABSTRACT: Current sexuality education programs vary widely in the accuracy of content, emphasis, and effectiveness. Data have shown that not all programs are equally effective for all ages, races and ethnicities, socioeconomic groups, and geographic areas. Studies have demonstrated that comprehensive sexuality education programs reduce the rates of sexual activity, sexual risk behaviors (eg, number of partners and unprotected intercourse), sexually transmitted infections, and adolescent pregnancy. One key component of an effective program is encouraging community-centered efforts. In addition...

ABSTRACT: In the weeks after birth, postpartum care often is fragmented among maternal and pediatric health care providers, and communication between inpatient and outpatient settings is inconsistent. To optimize postpartum care, anticipatory guidance should begin during pregnancy. During antenatal care, it is recommended that the patient and her obstetrician–gynecologist or other obstetric care provider formulate a postpartum care plan and identify the health care professionals who will comprise the postpartum care team for the woman and her infant. Ideally, during the postpartum period, a s...

ABSTRACT: Advances in the understanding of genetic conditions, reproductive technologies, and improved medical and surgical care have enabled an increasing number of women with genetic conditions to achieve a normal pregnancy outcome. However, management of certain genetic conditions during pregnancy is complex and may require a multidisciplinary approach from preconception through the postpartum period. Patients with certain genetic conditions, or those at risk of having a particular genetic condition, should have a preconception evaluation with their obstetrician–gynecologists, genetics spe...

ABSTRACT: Young women (aged 18–26 years) are a heterogeneous population transitioning from adolescence into adulthood who may present with unique issues and challenges, including a potential gap in health care after pediatric health care. Obstetrician–gynecologists should note that these patients may need assistance in transitioning from a pediatrician to a provider of adult health care (an internist, family practitioner, or obstetrician–gynecologist), especially in the absence of a parent. Preventive counseling is crucial for helping young women anticipate changes and stressors and for easin...

ABSTRACT: Rates of obesity in the United States have increased rapidly over the past several decades, and physicians should be prepared to care for obese patients in a nonjudgmental manner, being cognizant of the medical, social, and ethical implications of obesity. It is the responsibility of the physician to recognize the medical risks that are associated with obesity and to counsel the patient regarding these risks in an unbiased manner, respecting her autonomy and maintaining her dignity. Classifying obesity as a medical condition can serve to reduce bias toward obese patients and to chan...

ABSTRACT: Overweight and obesity are epidemic in the United States. Obesity is a risk factor for numerous conditions, including diabetes, hypertension, high cholesterol, stroke, heart disease, certain types of cancer, and arthritis. The prevalence of obesity is high, exceeding 30% in adult women and men. Many women, irrespective of demographic characteristics or income, are vulnerable to becoming overweight or obese because of limited resources for physical activity and healthy food choices, work commitments, and family demands. Clinicians and public health officials should address not only i...

ABSTRACT: The updated guidelines by the Institute of Medicine regarding gestational weight gain provide clinicians with a basis for practice. Health care providers who care for pregnant women should determine a woman’s body mass index at the initial prenatal visit and counsel her regarding the benefits of appropriate weight gain, nutrition and exercise, and, especially, the need to limit excessive weight gain to achieve best pregnancy outcomes. Individualized care and clinical judgment are necessary in the management of the overweight or obese woman who is gaining (or wishes to gain) less wei...

ABSTRACT: Increasing numbers of women and adolescent females are incarcerated each year in the United States and they represent an increasing proportion of inmates in the U.S. correctional system. Incarcerated women and adolescent females often come from disadvantaged environments and have high rates of chronic illness, substance abuse, and undetected health problems. Most of these females are of reproductive age and are at high risk of unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). Understanding the needs of incarcerated women and adol...

ABSTRACT: Underserved women are those who are unable to obtain quality health care by virtue of barriers created by poverty, cultural differences, race or ethnicity, geography, sexual orientation, gender identity, or other factors that contribute to health care inequities. With passage of the Patient Protection and Affordable Care Act Public Law 111–148 and 152, there is promise for increased health insurance coverage for underserved women. There is concern, however, that specific populations of underserved women may be left out. These women must continue to have access to existing safety net...

ABSTRACT: Sixty percent of American Indian and Alaska Native women live in metropolitan areas. Most are not eligible for health care provided by the federal Indian Health Service (IHS). The IHS partly funds 34 Urban Indian Health Organizations, which vary in size and services. Some are small informational and referral sites that are limited even in the scope of outpatient services provided. Compared with other urban populations, urban American Indian and Alaska Native women have higher rates of teenaged pregnancy, late or no prenatal care, and alcohol and tobacco use in pregnancy. Their infan...

ABSTRACT: Family history plays a critical role in assessing the risk of inherited medical conditions and single gene disorders. Several methods have been established to obtain family medical histories, including the family history questionnaire or checklist and the pedigree. The screening tool selected should be tailored to the practice setting and patient population. It is recommended that all women receive a family history evaluation as a screening tool for inherited risk. Family history information should be reviewed and updated regularly, especially when there are significant changes to f...

ABSTRACT: The goal of preconception care is to reduce the risk of adverse health effects for the woman, fetus, or neonate by optimizing the woman's health and knowledge before planning and conceiving a pregnancy. Because reproductive capacity spans almost four decades for most women, optimizing women's health before and between pregnancies is an ongoing process that requires access to and the full participation of all segments of the health care system.